Omeir Tariq Ansari, DDS
Individual provider Active NPI Dentist · Lake Mary, FL
NPI 1891337366 · NPPES record last updated Oct 16, 2019
Key facts
- NPI
- 1891337366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 24485 (FL)
- Practice address
- 3779 Lake Emma Rd
Lake Mary, FL 32746-6156 - Phone
- (407) 547-1359
- NPI assigned
- Oct 16, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200122000933 | FL | Order and Referring Only - Dentist |
3577998574 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24485 | FL | MD | Dentist |
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Mary Modern Dentistry, PA | Dentist | Past |
Accepting new patients |
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 24485 | FL | Yes |
Addresses
Primary practice location
3779 Lake Emma Rd
Lake Mary, FL 32746-6156
Mailing address
5305 Hawk Dr
Kissimmee, FL 34746
Phone (407) 749-9656
Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.